Bell's Palsy: Prognostic Criteria and Evaluation of Surgical Decompression

Mechelse, K.; Huizing, Egbert H.; Bolhuis, A.H. van; Goor, G; Hammelburg, E; Staal, A.; Verjaal, A

doi:10.1016/s0140-6736(71)92041-1

Cited by 34 publications

(12 citation statements)

References 12 publications

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“…Only 2 studies met inclusion criteria for this meta-analysis. 24,110 The pooled data from these studies did not show improved facial nerve outcomes for patients with surgical decompression of the facial nerve, although both studies used transmastoid decompression only. 105 May et al 111 and Aoyagi et al 112 also failed to show benefit of facial nerve decompression via a transmastoid approach.…”

Section: Supporting Textmentioning

confidence: 98%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

390

114

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Objective Bell’s palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell’s palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell’s palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell’s palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell’s palsy. Many of these tests are of questionable benefit in Bell’s palsy. Furthermore, while patients with Bell’s palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell’s palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell’s palsy. Purpose The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell’s palsy, to improve the quality of care and outcomes for patients with Bell’s palsy, and to decrease harmful variations in the evaluation and management of Bell’s palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell’s palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell’s palsy. The target population is inclusive of both adults and children presenting with Bell’s palsy. Action Statements The development group made a strong recommendation that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell’s palsy, and (d) clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure. The panel made recommendations that (a) clinicians should not obtain routine laboratory testing in patients with new-onset Bell’s palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell’s palsy, (c) clinicians should not perform electrodiagnostic testing in Bell’s palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset. The development group provided the following options: (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell’s palsy, and (b) clinicians may offer electrodiagnostic testing to Bell’s palsy patients with complete facial paralysis. The development group offered the following no recommendations: (a) no recommendation can be made regarding surgical decompression for patients with Bell’s palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell’s palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell’s palsy.

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Section: Supporting Textmentioning

confidence: 98%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

390

114

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“…During such decompression operations, nervous tissues become accessible for virological studies. However, since the therapeutic success of surgery is nowadays considered to be very limited (27), most studies on the etiology of Bell's palsy have necessarily been performed on non-invasively obtained non-nervous clinical specimens or on nervous tissues obtained during autopsies.…”

Section: Bell's Palsymentioning

confidence: 99%

“…In practice, the study of the hypothetically active HSV is quite difficult to organize, since one needs fresh nervous tissue from BP patients. Such tissue can only rarely be obtained: either during decompression operations, which are hardly performed any more (27), or at autopsy when the deceased patient had an acute Bell's palsy just prior to death. Since, by contrast, the study of latent HSV can be performed on autopsy tissues from unselected cadavers, latently infected ganglia have been studied quite extensively.…”

Section: The Human Facial Nerve and Hsvmentioning

confidence: 99%

Bell's palsy and herpes simplex virus

Schirm¹,

Mulkens

1997

APMIS

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Bell's palsy, which is defined as idiopathic peripheral facial paralysis of sudden onset, accounts for >50% of all cases of facial paralysis. Different theories on the etiology of Bell's palsy have been proposed and investigated. Various clinical studies have suggested an etiological link between Bell's palsy and herpes simplex virus (HSV). In addition, animal experiments have shown the ability of HSV to induce facial paralysis. In our opinion, the possible link between Bell's palsy and HSV can only be explored properly by studying the human facial nerve, and especially the geniculate ganglion itself. Different groups have tried to detect hypothetically reactivated and hypothetically latent HSV in the facial nerves of Bell's palsy patients and control patients, respectively. The isolation of infectious HSV from facial nerve tissue by conventional cell culture methods appeared to be very difficult, also when Bell's palsy patients were tested. Instead, modern molecular methods, such as in situ hybridization and the polymerase chain reaction (PCR) could easily detect HSV DNA in geniculate ganglia. The detection of HSV‐specific latency‐associated transcripts in the ganglia of control patients provided further evidence for the hypothetically latent state of HSV in the geniculate ganglia in these patients. Recent PCR experiments performed by a Japanese group strongly suggest that the area adjacent to the geniculate ganglia does not usually contain any HSV at all, except in patients with Bell's palsy. This well‐controlled study provides conclusive evidence that reactivation of HSV genomes from the geniculate ganglia is the most important cause of Bell's palsy. Consequently, it has been suggested that “Bell's palsy” be renamed as “herpetic facial paralysis”.

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“…Yanagihara and Kishimoto (1972) (11) were also able to demonstrate a statistically better outcome in patients who underwent surgery as compared with those who did not. In contrast to this Mechelse and his co-workers (1971) (50) found no significant difference in the two groups of patients in their series.…”

Section: Introductionmentioning

confidence: 71%

Facial nerver decompression

McNeill

1974

J. Laryngol. Otol.

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Bell's Palsy: Prognostic Criteria and Evaluation of Surgical Decompression

Cited by 34 publications

References 12 publications

Clinical Practice Guideline: Bell's Palsy

Clinical Practice Guideline: Bell's Palsy

Bell's palsy and herpes simplex virus

Facial nerver decompression

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